5 Alpha Reductase Inhibitors |
Abaloparotide |
Abilify Maintena |
Abraxane |
Abrilada |
Actemra |
Actimmune |
Aczone |
Adakveo |
Adapalene |
Adcetris |
Adempas |
Adenu |
ADHD Narcolepsy |
Aemcolo |
Afinitor |
Afrezza |
Aggrenox |
Aimovig |
Ajovy |
Aklief |
Akynzeo |
Albenza |
Aldara |
Aldurazyme |
Alecensa |
Alimta |
Aliqopa |
Aloquin, Quinja |
Aloxi |
Alpha-1 Proteinase Inhibitors |
Alunbrig |
Amiodarone (Formerly Cordarone) |
Amitiza |
Amjevita |
Ampyra |
Amzeeq |
Ancobon |
Androgens with QTY |
Angiotensin Receptor (ARB)/Thiazide Diuretic Combination Agents Step Therapy |
Antiepileptics |
Antihemophilic and Clotting Factors |
Antihypertensive Oral Solution |
Antipsychotic Medications Age and Step Therapy |
Anzemet Quantity Limit |
Apomorphine |
Aptivus |
Aranesp |
Arcalyst |
Argatroban |
Arikayce |
Arimidex |
Aristada |
Aristada Initio |
Arixtra |
Arthrotec |
Arzerra |
Asparlas |
Aubagio |
Austedo |
Avsola, Inflectra, Renflexis, Remicade |
Axid Oral Solution |
Ayvakit |
Azedra |
Azelaic Acid Agents |
Azilect |
Bafiertam |
Balversa |
Baraclude |
Bavencio |
Beleodaq |
Belrapzo |
Bendamustine |
Benlysta |
Beovu |
Berinert |
Besponsa |
Bevacizumab |
Bijuva |
Blincyto |
Blood Glucose Lancets |
Blood Glucose Test Strips and Monitors Step Therapy |
Bonjesta Diclegis |
Bosulif |
Botulinum Toxin |
Braftovi |
Brand Azelastine Nasal Spray Agents |
Brand Bupropion |
Brand EpiPen/EpiPen Jr. |
Brand Ophthalmic Allergy |
Breo Ellipta |
Breztri |
Brineura |
Brukinsa |
Buphenyl |
Buprenorphine SL Tablets for Medication Assisted Treatment |
Buprenorphine with Naloxone |
Buprenorphine with naloxone (FLHK Only) |
Buprenorphine-Naloxone GA Policy |
Buprenorphine-Naloxone LA Policy |
Buprenorphine-Naloxone NJ Policy |
Butorphanol Nasal Spray |
Cablivi |
Cabometyx |
Calcitriol Agents |
Calquence |
Cambia |
Caprelsa |
Carbaglu |
Cerdelga |
Cesamet |
Cetylev |
Chelation Therapy |
Chenodal |
Chloroquine |
Cholbam |
Cimzia |
Cinquair, Fasenra, Nucala |
Cinryze |
Cinvanti |
Cipro |
Clindamycin-Tretinoin Combination Products |
Codeine Agents Age Edit |
Colcrys |
Colony Stimulating Factors |
Cometriq |
Conjupri |
Consensi |
Continuous Glucose Monitors |
Contraceptive Products |
Copiktra |
Corlanor |
Cosentyx |
Cosmetic Anti-Aging |
Cotellic |
Cresemba |
Crofelemer |
Crysvita |
Cumulative Morphine Equivalent Dose (MED) for Opioid Analgesic Therapy |
Cycloserine |
Cycloset |
Cyclosporine Ophthalmic (Cequa, Restasis) |
Cyltezo |
Cyramza |
Cystaran |
Daklinza |
Daliresp |
Danazol |
Daraprim |
Darzalex |
Daurismo |
Dementia and Alzheimer's Disease |
Demser |
Depo-Estradiol |
Descovy |
Desoxyn |
Diabetic Test Strips |
Dibenzyline |
Dificid |
Dihydroergotamine |
Docetaxel |
Dojolvi |
Doptelet |
Dose Optimization |
Dose Optimization Mental Health |
Doxepin Cream |
Doxorubicin Hydrochloride Liposome |
Doxorubicin Liposome |
Doxycycline 40mg Rosacea Agents |
Doxycyclines - Acne |
Doxylamine Pyridoxine Agents |
DPP-4 Dipeptidyl Peptidase-4 |
Dronabinol agents |
Duavee |
Duexis |
Duloxetine (Previously Cymbalta, Irenka) |
Duobrii |
Duopa |
Dupixent |
Durlaza |
Durysta |
Duzallo |
Edurant |
Egrifta |
Elaprase |
Elidel |
Elitek |
Ellence |
Eloctate |
Elyxyb |
Elzonris |
Emcyt |
Emend Injectable |
Emend Oral |
Emflaza |
Emgality |
Empliciti |
Emsam |
Enbrel |
Endari |
Enhertu |
Enspryng |
Entresto |
Entyvio |
Enzyme Replacement Therapy For Gaucher Disease |
Epclusa |
Epidiolex |
Epiduo, Epiduo Forte |
Epinephrine - Self Injected Agents Quantity Limit |
Epivir |
Epogen, Procrit, Retacrit |
Equetro |
Eraxis |
Erbitux |
Erelzi |
Erivedge |
Erleada |
Erwinaze |
Esbriet |
Ethyol |
Eticovo |
Eucrisa |
Evekeo |
Evenity |
Evrysdi |
Evzio |
Exjade |
Eylea |
Fabrazyme |
Farydak |
Faslodex |
Ferriprox |
Firazyr |
Firdapse |
Fluoroquinolone Ophthalmics |
Fragmin Quantity Supply |
Fusilev |
Fuzeon |
Galafold |
GamaSTAN |
Gamifant |
Gattex |
Gavreto |
Gazyva |
Gilenya |
Gilotrif |
Givlaari |
Glatiramer (Copaxone Glatopa) |
Gleevec |
Gleostine |
Gloperba |
GLP-1 Long-Acting Insulin Combo |
GLP-1 Receptor Agonist Step Therapy |
Glycate |
Gocovri ER |
Gonadotropin Releasing Hormone Analogs (GnRH) |
Gralise |
Granisetron Agents Quantity Limit |
Grastek |
Growth Hormones |
Hadlima |
Haegarda |
Halaven |
Harvoni |
Hectorol |
Hemady |
Hepsera |
Herceptin Hylecta |
Hetlioz |
Hexalen |
Horizant |
HP Acthar |
Humira |
Humulin R U-500 |
Hyaluronan Injections |
Hyaluronan Injections (GA Only) |
Hycamtin |
Hydrocodone Containing Cough and Cold Agents Age Edit |
Hydroxyprogesterone caproate injection |
Hyrimoz |
Ibrance |
Ibsrela |
Iclusig |
Idhifa |
Ilaris |
Ilumya |
Iluvien |
Imbruvica |
Imfinzi |
Immunoglobulins |
Impavido |
Inbrija |
Increlex |
Infliximab/Infliximab-dyyb |
Influenza Virus Vaccine Quantity Limit |
Ingrezza |
Inhaled Corticosteroids (ICS) |
Injectable Triptan Agents Step Therapy |
Inlyta |
Inqovi |
Inrebic |
Intelence |
Interferons for MS |
Intravaginal Progesterone |
Invega Sustenna |
Invega Trinza |
Iressa |
Isotretinoin Agents |
Istodax |
Isturisa |
Ivacaftor-Lumacaftor |
Ixempra |
Jadenu |
Jakafi |
Jelmyto |
Jetrea |
Jevtana |
Juluca |
Juxtapid |
Jynarque |
Kadcyla |
Kalbitor |
Kalydeco |
Kanuma |
Katerzia |
Kesimpta |
Ketorolac |
Keveyis (dichlorphenamide) |
Kevzara |
Keytruda |
Khapzory |
Kineret |
Kisqali |
Korlym |
Koselugo |
Krystexxa |
Kuvan |
Kynamro |
Kyprolis |
Lacrisert |
Lartruvo |
Lemtrada |
Lenvima |
Letairis |
Levaquin |
Libtayo |
Lidocaine gel, cream, ointment |
Lidoderm (lidocaine) Patch |
Linezolid (ZYVOX) |
Linzess |
Long-Acting Opioid Analgesics PA-QL |
Lonsurf |
Lorbrena |
Lotronex |
Low Molecular Weight Heparins |
Lucentis |
Lumizyme |
Lumoxiti |
Lutathera |
Lynparza |
Lyrica CR |
Macugen |
Makena |
Marinol |
Mavenclad |
Mavyret |
Mayzent |
Megestrol acetate |
Meglitinide Step Therapy |
Mekinist |
Mektovi |
Mepsevii |
Mesnex |
Metformin extended-release |
Methotrexaate Auto-Injector Agents |
Migranal Nasal Spray |
Mirapex |
Mircera |
Mitigare |
Motegrity |
Movantik |
Mozobil |
Mulpleta |
Multisource Brand MSB Agents |
Myalept |
Mycapssa |
Mylotarg |
Naglazyme |
Namzaric |
Narc Analgesic Combo |
Narcan Nasal Spray |
Narcotic Dup |
Nasal Triptan ST |
Natpara |
Nayzilam |
Nerlynx |
Neumega |
Neupro |
Nexavar |
Nexletol |
Nexlizet |
Niacin Agents |
Nilandron |
Ninlaro |
Nitisinone |
Nocdurna (Nocura SL tablets) |
Noctiva Intranasal Spray |
Non-Formulary Prescription Request |
Non-Opioid Cough and Cold Agents Age Edit |
Non-Pegylated Interferons |
Non-Preferred 5-Aminosalicylic Acid Oral Agents Step Therapy |
Non-Preferred Agents for Actinic Keratosis |
Non-Preferred Angiotensin Receptor Blocker (ARB) Agents Step Therapy |
Non-Preferred Anti-Parkinson Agents |
Non-Preferred Beta Blocker Step Therapy |
Non-Preferred Ciprofloxacin |
Non-Preferred Epinephrine Injection |
Non-Preferred Fibrate Agents |
Non-Preferred Fluoroquinolone Otic Agents |
Non-Preferred Inhaled Corticosteroid (ICS)/Long-Acting Beta-2 Agonist (LABA) Combination Agents |
Non-Preferred Insulin Pen Needles |
Non-Preferred Insulin Syringe or Diabetic Syringe |
Non-Preferred Long-Acting Insulin Step Therapy |
Non-Preferred Long-Acting Muscarinic Agonist (LAMA) Agents Step Therapy |
Non-Preferred Minocycline |
Non-Preferred Nasal Corticosteroids |
Non-Preferred Ophthalmic Allergy and Mast Cell Stabilizer Agents |
Non-Preferred Ophthalmic NSAIDs |
Non-Preferred Oral/Transdermal 5-HT3 Receptor Antagonist |
Non-Preferred Oral Triptans Step Therapy |
Non-Preferred Overactive Bladder Agents Step Therapy |
Non-Preferred Pediculicides for Head Lice |
Non-Preferred Rapid Acting Insulin |
Non-Preferred Selective Serotonin Reuptake Inhibitors (SSRIs) Step Therapy |
Non-Preferred Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) |
Non-Preferred Short-Acting Beta-2 Agonist (SABA) Agents Step Therapy - DNA to WA |
Non-Preferred Skeletal Muscle Relaxants Step Therapy |
Non-Preferred Statins |
Non-Preferred Topical Agents for External Anogenital Warts Step Therapy |
Non-Preferred Topical Anti-Infective - Benzoyl Peroxide Combo Agents |
Non-Preferred Topical Corticosteroid - High Potency |
Non-Preferred Topical Corticosteroid - Low Potency |
Non-Preferred Topical Corticosteroid - Medium Potency |
Non-Preferred Topical Corticosteroid - Very High Potency |
Non-Preferred Topical Fluorouracil Agents |
Non-Preferred Vaginal Atrophy Agents |
Non-Sedating Antihistamines |
Noritate |
Northera |
Nourianz |
Noxafil |
NP LAMA-LABA |
Nplate |
NSA |
Nubeqa |
Nuedexta |
Nulojix |
Nuplazid |
Nurtec |
Nuvigil |
Nuzyra |
Ocaliva |
Ocrevus |
Octreotide |
Odactra |
Odomzo |
Ofev |
Ofloxacin Quantity Limit |
Olumiant |
Omega-3 Fatty Acid Step Therapy |
Oncaspar |
Ondansetron |
Ongentys |
Onpattro |
Onureg |
Onychomycosis |
Opdivo |
Opioid Analgesic Combo |
Opsumit |
Oral Antifungals |
Oral HIV Antiretrovirals Quantity Limit |
Oral Triptans |
Oralair |
Orencia |
Orenitram |
Orfadin |
Oriahnn |
Orilissa |
Orkambi |
Orlistat |
Ortikos |
Osmolex ER |
Osphena |
Otezla |
Oxandrin |
Oxbryta |
Oxervate |
Oxsoralen-Ultra |
Oxycontin |
Oxymorphone |
Ozurdex |
Padcev |
Palforzia |
Palynziq |
Pancreatic Enzymes |
Parsabiv |
Pemazyre |
Penicillamine |
Pennsaid |
Pepcid Oral Susp |
Perjeta |
Perseris |
Phesgo |
Phosphate Binders |
Picato |
Piqray |
Pizensy |
Plaquenil |
Pliaglis |
Polivy |
Pomalyst |
Praluent |
Pretomanid |
Prevymis |
Prialt |
Probuphine |
Procysbi |
Proleukin |
Prolia |
Promacta |
Prostacyclins for PAH |
Proton Pump Inhibitors |
Provenge |
Provigil |
Pulmozyme |
Purixan |
Qbrexza Cloth |
Qinlock |
Qualaquin |
Radicava |
Ragwitek |
Ranexa |
Ravicti |
Rayaldee |
Rayos |
Reblozyl |
Reclast |
Rectal Steroid Foam |
Regranex Gel |
Relenza |
Relistor |
Repatha |
RequipXL |
Retevmo |
Retisert |
Revcovi |
Revlimid |
Rexulti |
Rexulti -NV ONLY |
Reyvow |
Ribavirin |
Rilutek |
Rinvoq |
Riomet |
Risperdal Consta |
Rituxan |
Rozyltrek |
Rubraca |
Ruconest |
Rukobia |
Ruzurgi |
Rydapt |
Rytary |
Samsca |
Sandostatin |
Santyl |
Sarclisa |
Savella |
Scenesse |
Sedative Hypnotic Agents for Insomnia |
Sensipar |
Seysara |
SGLT2- DPP4 Inhibitor Combination |
SGLT2 Inhibitor Step Therapy |
Short-Acting Opioid Analgesics for Acute Pain Duration of Use |
Signifor |
Signifor LAR |
Siklos |
Sildenafil |
Siliq |
Simponi |
Simvastatin |
Single Agent NSAID Step Therapy |
Sirturo |
Sivextro |
Skyrizi |
Smoking Cessation |
Smoking Cessation (DC, GA) |
Solaraze |
Soliris |
Solosec |
Somatuline Depot |
Somavert |
Soolantra |
Sovaldi |
Spinraza - MD only |
Spravato |
Sprycel |
Stelara |
Stimate |
Stivarga |
Strattera |
Strensiq |
Stribild |
Subcutaneous Hormonal Implants (Formerly Testopel) |
Subutex |
Sucraid |
Sulfonylareas |
Sunosi |
Sutent |
Sylatron |
Sylvant |
Symdeko |
Symlin |
Symproic |
Synagis |
Synera |
Synribo |
Tabrecta |
Tadalafil |
Tafamidis Agents |
Tafinlar |
Tagrisso |
Takhzyro |
Taltz |
Talzenna |
Tamiflu |
Tarceva |
Targretin |
Tasigna |
Tasmar |
Tavalisse |
Taxotere |
Tazarotene Agents |
Tazverik |
Tecentriq |
Tecfidera |
Technivie |
Tegsedi |
Temodar |
teriparatide (Bonsity, Forteo) |
Testosterone Injectable |
Thalomid |
Thiazolidinedione Step Therapy |
Tibsovo |
Tildrakizumab |
Tiopronin Agents |
Topical Agents for Cutaneous Fungal Infections Step Therapy |
Topical and Buccal Agents for Recurrent Herpes Labialis |
Topical Anti-Infective-Benzoyl Peroxide Combo |
Topical NSAIDs |
Topical Onychomycosis |
Torisel |
Tracleer |
Tramadol Agents Age Limit |
Transdermal Estrogen |
Transmucosal Immediate Release Fentanyl (TIRF) Agents |
Trelegy Ellipta |
Tremfya |
Trientine |
Trikafta |
Triptan Quantity Limit |
Trodelvy |
Trogarzo |
Trulance |
Tukysa |
Turalio |
Tykerb |
Tymlos |
Tysabri |
Tyzeka |
Ubrelvy |
Uceris Oral Tablets |
Uloric |
Ultomiris |
Uplizna |
Upneeq |
Uptravi |
Valchlor |
Valtoco Nasal |
Vancomycin |
Varubi |
Vectibix |
Velcade |
Vemlidy |
Venclexta |
Verzenio |
Vesicare |
Vfend |
Viberzi |
Victrelis |
Vidaza |
Viekira |
Vimizim |
Vimovo |
Virazole |
Viread |
Vistogard |
Vitrakvi |
Vizimpro |
Vosevi |
Votrient |
Vumerity |
Vyepti |
Vytorin |
Vyvanse |
Wakix |
Xadago |
Xalkori |
Xatmep |
Xeljanz |
Xeloda |
Xenazine |
Xenleta |
Xermelo |
Xgeva |
Xiaflex Injection |
Xifaxan |
Xiidra |
Xofigo |
Xolair |
Xospata |
Xpovio |
Xtampza |
Xtandi |
Xuriden |
Xyrem |
Yervoy |
Yonsa |
Yosprala |
Yutiq |
Zaltrap |
Zavesca |
Zejula |
Zelapar |
Zelboraf |
Zelnorm |
Zemplar |
Zepatier |
Zeposia |
Zepzelca |
Zetia |
Zevalin |
Zilretta |
Zinbryta |
Zinplava |
Zithromax |
Zoledronic Acid |
Zolinza |
Zometa |
Zontivity |
Zovirax (acyclovir) Topical Agents |
Ztlido |
Zulresso |
Zurampic |
Zyclara |
Zydelig |
Zyflo |
Zykadia |
Zyprexa Relprevv |
Zytiga |